On average, more than 26,000 children under the age of five die each day, most of them from preventable causes.

The annual number of child deaths has been halved, from roughly 20 million in 1960 to 9.7 million in 2006.

More than 80 per cent of all under-five deaths in 2006 were in sub-Saharan Africa and South Asia.

Overall, the regions that are not on track to meet the MDG 4 child survival targets are the Middle East and North Africa, South Asia and sub-Saharan Africa, including both Eastern and Southern Africa and West and Central Africa.

Of the 46 countries in sub-Saharan Africa, only three are on track to meet MDG4: Cape Verde, Eritrea, and Seychelles.

In order to reach the MDG target for child survival, we must halve child mortality rates again by 2015. The global U5MR in 2006 was 72 per 1,000. This needs to fall to 31 per 1,000 by 2015.

Sub-Saharan Africa has accounted for a steadily growing proportion of under-five deaths since 1970, when the region accounted for 11 per cent of worldwide births and 19 per cent of child deaths. In 2006, sub-Saharan Africa, accounted for 22 per cent of global births and 49 per cent of under-five deaths.

A child born in sub-Saharan Africa in 2006 has a one in six chance of dying before his or her fifth birthday.

Progress since 1990:

Since 1990, 61 countries have reduced child mortality rate by at least 50 per cent.

Of the 191 countries with available data, 129 are on track to meet the MDG 4 target for child survival – to reduce under-five deaths by two-thirds by 2015.

Almost one-third of the 50 least developed countries have reduced child mortality rates by 40 per cent or more since 1990 – proof that progress for children can be made in poor countries if political will and sound strategies are in place. These countries include Maldives, Timor-Leste, Bhutan, Nepal, Bangladesh, Lao PDR, Eritrea, Haiti, Malawi, Samoa, Cape Verde, Comoros, Mozambique, Ethiopia, and Solomon Islands.

The under-five mortality rate (U5MR) in China has declined from 45 deaths per every 1,000 live births in 1990 to 24 in 2006 – a 47 per cent reduction.

India’s U5MR has declined by 34 per cent.

In seven countries: Bangladesh, Bhutan, Bolivia, Eritrea, Lao PDR, Timor-Leste and Nepal, child mortality has been reduced by 50 per cent or more.

There has been a 40 per cent drop in child mortality in Ethiopia.

The 2006 global under-five mortality rate was 72 deaths per 1,000 live births – 23 per cent lower than the 1990 level.

Maternal Health and Mortality:

A common factor in child deaths is the health of the mother, over 500,000 of whom die from pregnancy or childbirth related complications every year.

In the developing world, one-quarter of pregnant women do not receive a single antenatal care visit from a skilled health professional.

Girls under 15 are five times more likely to die in childbirth than women in their twenties.

If a mother is under 18, her baby’s chances of dying during the first year of life are 60 per cent higher than those of a baby born to a mother older than 19.

In the least developed countries only 27 per cent of women aged 15- 49 give birth in a health facility.

The lifetime risk of a woman dying from pregnancy related causes is 1 in 17 in West and Central Africa compared to 1 in 8000 in industrialized countries.

Factors aggravating child mortality:

The major causes of death for children under five are: neonatal causes (36 per cent), pneumonia (19 per cent), diarrhoea (17 per cent), malaria (8 per cent), measles (4 per cent) and AIDS (3 per cent).

1 in 5 people do not have access to improved sources of drinking water and roughly half are without adequate sanitation.

The number of children dying from diarrhoeal diseases is estimated at nearly 2 million per year; or around 17 per cent of all under five child deaths.

Educating and empowering women has direct benefits for the survival, health and development of their children. Yet estimates show that almost 1 in every 4 adults (defined here as those ages 15 and over) is illiterate, with women affected disproportionately.

Conflict often leads to complex emergencies – a situation involving armed conflict, population displacement and food insecurity, with particularly lethal consequences for children. Presently, more than 40 countries (90 per cent of them low–income nations) are dealing with armed conflict.

Most of major killers of children in complex emergencies are the same as the top killers of children in general: measles, malaria, diarrhoeal diseases, acute respiratory infections, malnutrition.

Highest mortality rates among refugee populations tend to occur among children under five.

Of the 11 countries where 20 per cent or more of children die before the age of five (Afghanistan, Angola, Burkina Faso, Chad, DRC, Equatorial Guinea, Guinea-Bissau, Liberia, Mali, Niger and Sierra Leone) – more than half have suffered a major armed conflict since 1989.

Niger, where women have a one in seven lifetime risk of dying during pregnancy or childbirth.

Sierra Leona and Afghanistan, where pregnant women have a one in eight lifetime risk of dying;

Chad, where pregnant women have a one in 11 lifetime risk of dying.

Lowest:

Argentina, where the lifetime risk of death during pregnancy or childbirth is one in 530;

Tunisia, where the lifetime risk of death during pregnancy or childbirth is one in 500;

Jordan, where the lifetime risk is one in 450;

Interventions:

Measles deaths have fallen by around 68 per cent worldwide and by more than 90 per cent in Africa, since 2000.

It is estimated that policy interventions to eliminate poverty and inequalities, bringing child mortality rates in the poorest 80 per cent of the population up to par with those of the richest 20 per cent, would have a dramatic effect on the under-five mortality rate. Worldwide, about 40 per cent of under-five deaths could be prevented.

Evidence shows that using a combination of community outreach programmes and family-community care strategies at 90 per cent coverage could reduce neonatal mortality by 18-37 per cent.

In sub-Saharan Africa, UNICEF, WHO and World Bank collaborated in 2006 on an analysis of the cost of reducing child mortality by scaling-up existing interventions delivered through effective, community-based health services:

Phase one – the minimum package – would lead to an estimated 30 per cent reduction in the region’s U5MR, and a 15 per cent fall in MMR at an estimated incremental annual cost of $2-3 per capita, or around US $1,000 per life saved;

Phase two – expanded package – would cut U5MR by an estimated 45 per cent, MMR by 40 per cent and neonatal deaths by around 30 per cent at an estimated incremental annual cost of about $5 per capita, or less than $1,500 per life saved;

Phase three – effective coverage with the maximum package – would allow countries to meet or approach all the health-related MDGs by cutting U5MR and MMR by more than 60 per cent, cutting the neonatal mortality rate by 50 per cent and halving the incidence of malaria and undernutrition at an estimated incremental annual cost of $12-15 per capita, or around $2,500 per life saved.